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Thank you for participating in the important role as a research and scholarly activity mentor. The purpose of this form is to briefly describe your research interests and the type of projects that you are willing to supervise. Our intention is that residents/learners will have access to this information so that we can proactively match residents/learners and mentors.

Note: Research and scholarly activity mentors/supervisors are expected to be faculty members with some experience in research methods and publication (i.e., have published 2 or more papers in peer-reviewed journals in the past 10 years). For any studies conducted in human or animal subjects, the supervisor must be registered in the RISe system (including an up-to-date Conflict of Interest/Commitment statement).

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* 1. Supervisor Name (Last name, First name)

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* 2. Supervisor Email

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* 3. Location of supervisor (check all that apply)

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* 4. While the predominant focus is research supervision of residents, there is also request for supervision from other interested learners, including medical students and clinical faculty, and for other types of scholarly activity (e.g., presenting a Grand Rounds).

Which type of learners are you willing to supervise? (Check all that apply)

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* 5. Key words for project/research (check all that apply)

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* 6. Clinical populations for project/research (check all that apply)

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* 7. Description of Research (briefly describe, in 1-2 paragraphs, your research program)

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* 8. Briefly describe some sample projects for learners

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* 9. Potential Learner Roles and Activities (check all that apply)

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* 10. Other comments and ideas are welcome! What can we do to make it easier for you to mentor residents?

Thanks for completing the form! Please let Raymond Lam know that you've completed it by emailing r.lam@ubc.ca

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